创伤患者血浆降钙素原与创伤严重程度全身性感染器官衰竭及死亡率之间关系的研究

Study of relationship between serum procalcitonin levels and severity of injury, sepsis, organ failure, and mortality in injured patients

目的 分析比较创伤患者血浆降钙素原 (PCT)水平和全身炎症反应综合征 (SIRS)、感染、多器官功能障碍综合征 (MODS)的发生率和严重程度 ,并评估PCT对这些创伤后并发症的预测价值。方法 对急诊抢救和入住重症监护病房 (ICU)的机械性创伤患者在创伤严重程度、感染性并发症的发生、器官功能不全及死亡率等方面进行回顾性分析 ,在入院当天和第1、3、5、7、10、14和 2 1天分别采集血标本 ,采用免疫发光法检测血浆PCT。结果 机械性创伤导致的血浆PCT升高与创伤严重程度相关 ,在第 1～ 3天达到峰值 ,并在 2 1d内逐渐下降。与没有发生SIRS的患者相比 ,发生SIRS患者的血浆PCT水平升高显著 (P <0 0 5 )。在创伤后第 1天 ,创伤后病情平稳的患者血浆PCT水平为 1 0± 0 3μg/L ,而伴有全身性感染、多器官功能不全患者的血浆PCT水平分别为 7 0± 3 2、5 5± 2 6 μg/L ,且其在创伤早期血浆PCT浓度最高 ,并维持在高水平约 10～ 14d。创伤后 3d内血浆PCT水平升高预示严重的SIRS、全身性感染和MODS的发生 (P <0 0 0 0 1)。结论 PCT水平升高可以作为一项对创伤患者发生全身性感染和MODS敏感的和有预测意义的指标 ,常规监测血浆PCT有助于早期认识创伤后并发症。因此 ,PCT可以作为一个有价值的指标来监测高危创伤患?

Objective To compare procalcitonin (PCT) plasma levels of injured patients with the incidence and severity of systemic inflammatory response syndrome (SIRS), infection, and multiple organ dysfunction syndrome (MODS) and to assess the predictive value of PCT for these posttraumatic complications. Methods We retrospective studied patients with mechanical trauma in terms of severity of injury, development of infectious complications, and organ dysfunctions. Two hundred and sixty injured patients with injury severity score ≥9 points were enrolled in this study from January 2002 to January 2004. Blood samples were collected on the day of admission and on days 1,3, 5, 7, 10, 14, and 21 thereafter. We determined PCT serum levels using a specific immunoluminometric assay. We retrospectively evaluated the occurrence of SIRS, sepsis, and MODS using patients' charts. Results Mechanical trauma led to the increase of PCT plasma levels which was dependent on the severity of injury, with peak values on days 1 and 3 ( P <0 05) and a continuous decrease within 21 days after trauma. Patients with SIRS demonstrated a significant increase of peak PCT plasma levels ( P <0 05) compared with patients without SIRS. The highest PCT plasma concentrations early after injury were observed in patients with sepsis (7.0±3.2 μg/L, day 1) or severe MODS (5.5±2.6 μg/L, day 1) with a sustained increase ( P <0 05) for 14 days compared with patients with an unevenful posttraumatic course(1.0±0.3 μg/L). Moreover, the increase of PCT plasma levels during the first 3 days after trauma predicted ( P <0.0001; logistic regression analysis) severe SIRS, sepsis, and MODS. Conclusions These data indicate that PCT was a sensitive and predictive indicator of sepsis and severe MODS in injured patients. Routine analysis of PCT levels seems to be helpful in early recognition of these posttraumatic complications. Thus, PCT may be a useful marker to monitor the inflammatory status of injured patients at risk.